Signifor (pasireotide) — Highmark

Initial criteria

• age ≥ 18 years
• diagnosis of Cushing’s disease (ICD-10: E24.0)
• prescribed by or in consultation with an endocrinologist
• member is not a candidate for pituitary surgery OR pituitary surgery has not been curative

Reauthorization criteria

• member has experienced a reduction in 24-hour urinary free cortisol (UFC) levels from baseline
• prescriber attests to an improvement in signs and symptoms of Cushing’s disease from baseline

Approval duration

initial up to 6 months (12 months for Delaware Commercial fully-insured and ACA members); reauthorization up to 12 months